Provider Demographics
NPI:1629882923
Name:WHITE, BAILEY MICHAEL (CPSS)
Entity type:Individual
Prefix:MR
First Name:BAILEY
Middle Name:MICHAEL
Last Name:WHITE
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2705
Mailing Address - Country:US
Mailing Address - Phone:801-440-3321
Mailing Address - Fax:
Practice Address - Street 1:440 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2705
Practice Address - Country:US
Practice Address - Phone:801-440-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF24-115531175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist